The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Sunday, January 10, 2010

British criminal records checks 'delay children's operations'

The usual British bureaucratic madness

Children's operations are being delayed and cancelled as surgeons face criminal records checks every time they work in a different part of the country, it has been warned. Specialist surgeons working with children face delays in being cleared to start work when covering for colleagues on sick leave at other hospitals.

The repeated checks can take months and the problem is leading to delays and cancellations in treatments for children, the Royal College of Surgeons has warned. They called for surgeons to be issued with 'passports' so their CRB (Criminal Records Bureau) check from one NHS organisation is valid in another.

Richard Collins, Vice-President of the Royal College of Surgeons, said: “It is absolutely right that there should be robust checks for anyone who works with children, but there needs to be some common sense to ensure patients don’t suffer. "The NHS needs flexibility to enable surgeons in specialist fields to undertake operating lists in other Trusts, often on an ad hoc basis. To require them to repeat the same time-consuming bureaucratic process each time is a completely unnecessary delay that must be revised.”

Surgeons work on the basis of sessions, usually half days, in outpatients clinics or operating and most can take up sessions at another hospital in addition to their normal workload if necessary. The extra locum work is particularly important in highly specialised areas where there may be only a few surgeons able to carry out the work. Surgeons also move between NHS trusts regularly while training.

The experience of David Jones, paediatric orthopaedic surgeon at Great Ormond Street Hospital, is one example of how the system is causing problems. He was asked to cover a colleague’s sickness leave in Leeds over December and January but the CRB check has taken so long all the clinics and operations he was due to do have been delayed. He said: “Despite filling out all the documentation at the beginning of November, the process dragged on in spite of many phone calls to CRB from Leeds General Infirmary. "All the clinics and lists planned for December had to be cancelled, thereby causing large numbers of very upset families. In December, I wrote to The Secretaries of State for Children, Skills & Family; The Home Office and Department of Health along with Senior Management of NHS but have had no response.

"This week’s clinics were also cancelled. My clearance finally came through on Thursday and we are trying to get clinics set up for next week. I think more than a month has been wasted needlessly and many children and their families seriously let down.”

Dr Shree Datta, Chairman of the British Medical Association’s Junior Doctors Committee, said: “There have been issues for several years with the CRB system, particularly for junior doctors, who frequently move between posts. “In theory, the checks should already be portable - it’s entirely up to employers whether they accept previous clearance. Having to go through the process every time you move to a new hospital - which can be every six months - can result in delays in taking up posts. "The other big issue is the amount of money it costs the NHS to repeat checks unnecessarily. Clearly the safety of children is paramount, but we’d like to see a more common sense approach, with improved communication between hospitals."

A spokesman for the Department of Health said: "We recognise that there have been occasions when the requirement to undertake a check through the CRB has created local administrative difficulties. However, the requirement to undertake a CRB check provides an important safeguarding measure which should be observed in full by the NHS."

A spokesman for the Home Office said: "In the case of surgeon David Jones, the CRB completed his check within its published target of 28 days. The CRB did not receive his application until 4 December, despite Mr Jones signing his application form four weeks earlier. "The CRB is currently receiving unprecedented demand for its service and as a result, some Enhanced checks are now taking slightly longer to complete. "Despite this increasing level of demand, the CRB is continuing to process almost 90 per cent of Enhanced checks within the 28 day target.”

Can we trust Congress to do the reasonable thing and go slow and deliberate on health reform? With the daily onslaught of Obamacare propaganda I doubt it.

First, it is not true that the entire world, or even Europe, is committed to socialized medicine. For every testimonial to government health care, you can find a horror story. Second, it is not true that insurance companies are the primary problem. Fact is they average a 2.5 percent profit margin, which is comparable to your local supermarket.

Fact is that Medicare is twice as likely to deny a claim as is a private insurer. Let the feds allow insurance companies to compete across state lines, give them protection from predatory lawyers and make it possible for individuals to get the same tax breaks on insurance plans that big corporations do.

Next, it is not true that 46 million Americans cannot get health insurance. Nine million of those are not U.S. citizens, and we're waiting for Congress to settle the issue of illegal immigration. Another 9 million of that figure are on Medicaid but incorrectly stated on their census that they were uninsured.

Fact is 90 percent of Americans are insured and of the remaining 10 percent nearly half make $50,000 a year (26 percent more than $75,000). So I ask: Is it reasonable to overhaul the health care of 300 million Americans to deal with an issue that affects 5 percent of the population?

It is also not true that this legislation will have a major cost-saving effect. In my lifetime health care has gone from 3 percent to 17 percent of the Gross National Product. Technologically, we are approaching the point where we can do more than we can afford. As mentioned, insurance profits account for only a tiny slice of the pie. By far the greatest costs come from paying for good health care personnel and buying quality medical supplies.

Have these issues been confronted?

Even worse, the true price tag of this plan is being hidden. Unlike the presentation of the Clinton health care plan, this time the cost of individual and employer mandates is not being openly stated. Instead of the $848 billion Harry Reid bill, we are looking at a $2.1 trillion Reid bill. (See Michael Cannon of the Cato Institute.)

Finally, the most hurtful untruth is the accusation that those opposing this bill are selfish and uncaring. It is the classical liberal ruse of class warfare. First, the contributions of volunteer supplied community health clinics and the success of health care sharing ministries is ignored. Second, the fact is the vast majority are not opposed to some kind of government help to the down and out.

We do have the reasonable expectation, however, that the government get its financial house in order and put Medicare and Medicaid in the black before taking on even more. Maybe its time to change eligibility requirements for Medicaid or Medicare, perhaps to include those with chronic diseases. Maybe we need more programs like Florida Kids Care. Make your case and tell me how much tax money you need, but don't call my reluctance to let bureaucrats make my family health care decisions uncaring!

Third, there are a lot of people who sincerely think that a government-run system could never be as efficient and caring as unfettered private health care.

Fourth, many of us believe that the real selfishness lies with those who want all the benefits now but are content to stick the bill with seceding generations. Given the out-of-control spending on Capitol Hill, I don't trust them with the future health care of my children and grandchildren.

One of the key voices for Congressional health care legislation, MIT economist Jon Gruber, is taking fire from the precincts of the left that oppose the Senate plan over the fact that he is on contract with Department of Health and Human Services.

He's been paid $297,600, according to federal documents, to produce "a technical memorandum on the estimated changes in health insurance coverage and associated costs and impacts to the government under alternative specifications of health system reform." The contract, which was awarded June 19, wasn't widely known or regularly disclosed.

"[D]on’t you think it’s rather, um, dubious that the guy evaluating the heath care reform–for $300,000–is also the package’s single biggest champion? And no one has been transparent about this contract?" writes Firedoglake blogger Marcy Wheeler of the contract, which was first mentioned on DailyKos.

I asked Gruber about the reports, and he responded by stressing that the contract was not for public relations, but for analysis, and that he's long advocated for a consistent set of policies:

I do indeed have a contract with HHS. Throughout this year I have provided technical assistance to the administration and to Congress with my micro-simulation model, as well as based on my experience as a member of the Massachusetts health connector board. But NONE of the work I have done in public, or any public declarations I ahve made, has been in any way funded by the Administration. That funding was strictly for internal work that I did for the administration and, via the administration, for congress. All externally visible work and comments, such as my editorials or public reports, have been done on my own time.

Moreover, at no time have I publicly advocated a position that I did not firmly believe - indeed, I have been completely consistent with my academic track record. On the two issues this article raises:

1) I am known in economics as one of the leading experts on the impact of health insurance costs on wages - indeed, I wrote my thesis on that topic and have written extensively since on the fact that health insurance costs are fully translated into wages. I was asked by the editors of the Handbook of Health Economics, a review of literature in this area, to write the review article on this topic.

2) In my role as a member of the MA Health Connector board, I had to help decide what were affordable subsidies for our citizens. I was surprised to find how little work there was on this topic so I undertook a study to help lay out what might be considered affordable. I have since replicated that analysis at the federal level. Every position I have advocated on this topic is completely consistent with these reports.

Gruber told POLITICO that he has told reporters of the contract "whenever they asked" and noted that he formally disclosed that "I am a paid consultant to the Obama Administration" in a form attached to his most recent, December 24 article in the New England Journal of Medicine, though it wasn't widely known by reporters on the beat.

A Democratic senator says party leaders should open health care negotiations to C-SPAN cameras, echoing Republicans who have called for greater transparency.

Missouri Sen. Claire McCaskill said in a statement Friday that hundreds of hours of debate on health care have been open and further talks between the House and Senate should be on C-SPAN.

C-SPAN chief executive Brian Lamb sent a letter to congressional leaders this week asking for the talks to be opened to cameras. As a candidate, President Barack Obama pledged during a January 2008 debate that negotiations would be on C-SPAN.

Democrats say they have kept Americans informed throughout the process. Republicans have criticized them for taking the final, most crucial stage of the discussions behind closed doors.

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Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here